episode_0008

Episode 8. Going to work in the ward (3)

****

Now I have to adjust the arm bone. I’m already sorry, this is going to hurt a lot just trying to do it. I gritted my teeth and looked at the patient’s arm.

It depends on how the arm bone is broken.

If the bone is broken in one or two places, there will be a sense of alignment. If it is broken in multiple places or the bone is crushed, it will not be aligned by fiddling with it from the outside.

It’s just going to hurt a lot.

I held the patient’s hand tightly with my left hand and placed my right hand on the injured area. It’s going to hurt. It’s going to really hurt… … .

“One, two, three and you’ll get your bones aligned.”

“Eeeep!”

Come to think of it, I guess I muzzled him. It might be a bit difficult for the patient to answer.

“One, two!”

I tried to set the patient’s broken arm, but I couldn’t feel the broken bones touching each other. Should I assume this is a comminuted fracture?

Judging by the freedom of movement of the broken arm, it seems that both humeri are broken. They were completely bent when he first came in.

This confirms the patient’s diagnosis.

“Eww! Ewww! Eww!”

“Look, Istina. Am I right? If it’s a comminuted fracture, the bone won’t be aligned and you’ll just be in so much pain that you’ll die.”

“Ugh!”

The patient tried to say something, but I couldn’t understand what he meant. I think he probably meant something like it hurt.

“That’s why I told you to muzzle him. If this continues, the patient will be in big trouble if he bites his tongue.”

“Okay, I understand.”

Istina nodded vigorously.

****

I made eye contact with the patient again.

“Patient! I think you have a comminuted fracture. Your bone is crushed. If you leave it like this, regardless of healing magic, you will never be able to use your arm properly again. This needs surgery.”

Istina frowned.

“Su, surgery? It seems a bit dangerous. Can’t you fix it with a splint or bandage?”

“Eeeeek!”

No. I shook my head.

“My arm is twice as swollen. Can I bandage it? Of course not.”

“Eeeeek! Eeeeek!”

The disease suspected now is compartment syndrome.

It is a disease in which blood does not circulate properly inside the muscles due to increased pressure within the fascia.

In this patient’s case, it is thought that the pressure within the fascia increased due to trauma and swelling.

“Istina. Look. Her arm is broken, but her color is not good except for the bruises and her pulse is not good. This is typical compartment syndrome. The pressure within the fascia is abnormally high due to trauma. Doesn’t it look like surgery is needed?”

This time, too, she had an expression of ignorance. Istina frowned and looked at the patient’s arm, then sighed.

“How would I know that…? No, Professor, do you know that just by looking at the arm?”

“Don’t be so slurry. I’m busy.”

“I don’t know.”

It’s natural to not know, but if you don’t know, the patient could die. That’s the reality of our industry. Well, it’s fortunate that I don’t know now.

I made eye contact with the patient.

“Patient. You need surgery urgently. If you agree, please nod your head.”

“Ugh! Eeeek!”

I don’t know if he agreed or not. Should I just say he nodded? Or did he just shake his head in fear? He could die if he doesn’t get the surgery anyway.

Because the current condition is not limited to the arm.

“Nurse! Please prepare for surgery.”

A few ward nurses came running. I turned my head toward Istina.

“Let’s get ready for surgery, too. I told you. Wash your hands, sterilize the surgical equipment, and keep your hair and dust out.”

****

Preparing for surgery.

Istina and I disinfected our hands and came to the operating room wearing robes and masks. The masks looked a bit strange.

It was a plague doctor’s beak mask, but it was better than nothing. There’s no proper operating room here.

No anesthesiologist, no respirator… … .

Well, this is not a situation where general anesthesia can be administered. This is a situation where orthopedic surgery must be performed while the patient is conscious.

My plan was this.

They give you propofol as a sedative, put you on a fentanyl patch, and then they put you under local anesthesia on your forearm. It’ll hurt a lot, but it’s better than not being able to use your arm properly for the rest of your life.

maybe?

Istina looked worried.

The patient also had a worried expression on his face.

Come to think of it, maybe we had to tie the patient down because he was having trouble moving? He was barely moving due to the effects of the fentanyl patch.

Modern medicine has been summoned with its powers. Other preparations have also been completed. This is the first time in this world that a real surgery has been performed… … .

I’m a bit nervous.

“Istina. When the surgery starts, hold the patient down and hold them down. If they move during the surgery, something serious could go wrong.”

“I’m sorry, but even if the patient’s bone is broken, what can we do by opening the wound? I don’t know if this is a good idea.”

I looked at Istina.

“Istina. Be quiet. Don’t make the patient anxious and just sit up straight. We’ll open up the broken part of your arm and reassemble the bone.”

“After assembling it with surgery?”

“Huh? The mesh and the iron plate will put the bone back in place. If you don’t have this surgery, you might never be able to use your arm properly.”

Still looking in disbelief.

“This is my first time seeing this method… … .”

Everything is planned.

I placed a boiled and sterilized cloth on the floor, and then I placed a boiled and sterilized gauze on the patient’s arm. That was it.

“Purification magic.”

Istina used purification magic. I applied alcohol around the patient’s wounds.

“Take medicine.”

The patient nodded.

There are three types of planned anesthetics.

I applied a fentanyl patch to the patient’s chest, injected propofol into a vein in his arm, and finally injected lidocaine, a local anesthetic, into his arm.

As soon as the lidocaine needle was removed, interstitial fluid oozed from the patient’s wound, as if a water balloon had been pricked. This finding suggested compartment syndrome.

Currently, this patient is suspected of having fractures of the radius and ulna, and compartment syndrome may also be suspected due to intrafascial hemorrhage and edema.

In a real hospital, the former could have been confirmed with an X-ray and the latter with a blood test.

There’s nothing you can do here except open your arms yourself.

“The knife is now going in.”

I took a deep breath and then applied the scalpel to the patient’s arm. I cut the skin, cut the subcutaneous fat layer, and cut the fascia. When I cut the patient’s fascia, a lot of blood-mixed liquid flowed out.

“Istina. Look at this. The pressure in the fascia must have been quite high. In just a few hours, the arm would have been necrotic. ”

“Oh my, is that so… … .”

“Ouch! It hurts so bad!”

Well, that’s it for anatomy time.

Let’s stop looking inside your arm and finish the surgery quickly. Even though you used anesthesia, it looks like it hurts a lot. Is it because your constitution doesn’t respond well to anesthesia?

When performing an endoscopy under sleep, propofol is often used to sedate the patient. The general public calls it sleep anesthesia, but strictly speaking, it is not anesthesia.

Propofol is a sedative, and when administered in large doses, it can induce a sleep-like state. The correct term is conscious sedation.

If you use too much propofol, you may experience respiratory distress or other side effects similar to narcotic overdose. It is best to finish the surgery quickly.

“Are you awake, patient? We are currently using three types of anesthetics. It seems you have a special constitution that does not respond well to anesthesia.”

“Kkaaah!”

“… … .”

“Oh, I’m sorry. I’ll finish the surgery quickly. Istina, put the gag back on the patient. You’ll bite your tongue if you scream.”

Istina put the handkerchief back in the patient’s mouth. I looked through the open wound on his arm, tearing at the muscle and staring at the bone.

“Istina. Look here. Do you see the broken bone between the muscles? I’m going to put a steel rod in there and straighten the bone. It’s going to be hard, but.”

“That’s amazing.”

I am not an orthopedic surgeon.

I only saw the surgery when I was a trainee and assisted a few times when I was an intern. But now, I am this patient’s only hope. If I don’t do it, he will never be able to use his arm.

If the surgery doesn’t work out, we can use healing magic to somehow save him. If we go in this direction, it will be difficult for the patient to use his arm properly. That’s something we’ll think about when the time comes.

Iron core. To be exact, titanium plate. Strictly speaking, it’s not a drug, so I was worried whether I could summon this. But for some reason, I was able to.

It looks like you can bring objects smaller than your palm. Or are they included because they fit on your body?

I don’t know about that.

I had a titanium plate attached to my bone. I don’t know if this is the right way to do it. Nails went into each hole in the titanium plate.

It seems to be fixed at this point, although there is no way to check right now.

“Istina. Right now, I only have a plate attached to the radius. Is it right to leave the spine like this, or is it better to make another incision? I don’t have the confidence to attach a plate to the spine like this.”

Istina turned her beak mask towards me.

“Oh, right. Isn’t it a bit much to do another incision? And. You can ask me, I don’t know.”

“Yeah, I guess I’ll just have to dig in.”

“Eeeeek! Eeeeek! ”

I don’t think it’s right to make another incision. I nodded. It seems like the patient is also telling me not to make another incision.